AB1235 MULTISYSTEM INFLAMMATORY DISEASE IN CHILDREN (MIS-C) IN SINGAPORE CHILDREN: ARE WE DIFFERENT?
Authors: L. Das, K. L. Teh, X. Gao, T. Arkachaisri
Journal: Annals of the Rheumatic Diseases (2022)

Background Multisystem Inflammatory Syndrome in Children (MISC) is a hyper-inflammatory state with similarities to Kawasaki Disease, 4 to 6 weeks after Covid-19 infection 1 . Literature describes a 11:1 Relative Risk for Asian children versus Caucasians 2 . Since the start of the pandemic, 17,699 children under 12 years were infected with Covid-19 3 . Objectives To describe presentation and short term outcomes, for a cohort of children with MIS-C at the sole Children’s Hospital in Singapore. Methods Demographic and clinical/lab data were collected from children diagnosed with MIS-C accrording to the WHO criteria 4 at KK Woman’s and Children’s Hospital, Singapore. Nonparametric descriptive statistics were used to describe and analyse data. Results Eleven patients were diagnosed with MIS-C between October 2021 and Jan 2022. Seven (64%) were male and 4 (36%) were Chinese, with median age at presentation was 8.08 years (IQR 4.54 - 9.79). All patients had positive COVID-19 serology at the time of diagnosis. Median duration of fever prior to diagnosis was 5 days (IQR 4 - 5); Nine (82%) had gastrointestinal symptoms and median number of Kawasaki Disease (KD) features were 2 (IQR 2 - 3.5); common manifestations were conjunctivitis (90%), red lips (55%) and rash (36%). Of note, 8 (70%) patients had KD type peeling on follow-up. No BCGitis was found during acute phase. Seven (64%) were admitted to higher dependency care. Table 1, all patient received IVIG and IV steroids; 6 (55%) as pulse (30mg/kg/day) therapy. Patient 8, additionally received Anakinra. Median duration of admission was 6 days (IQR 5-13). One patient developed complications post therapy and was re-admitted to hospital for hematochezia. Treatment involved stopping Enoxaparin and Prednisone. Aspirin was resumed as soon as bleeding ceased. Laboratory characteristics and outcomes are denoted in Table 1. All patients had a monophasic course during the median of 10 weeks (IQR 8 - 11.5) of follow-up. Table 1. No Age (yr ) GI symptoms KD features Hemoglobin (g/DL ) Absolute Lymphocyte (10x9/L ) Platelet (10x9/L ) CRP (mg/L ) D-Dimer (mg/L FEU ) Ferritin (ug/L ) Enoxaparin started Peeling Abnormal echo 1 10 YES 2 12.2 0.23 67 173.2 32 3179.1 YES YES YES 2 11 NO 2 14.8 1 166 94.9 2.51 350 NO YES YES 3 4.25 YES 2 10.4 1.02 241 134.6 6.05 277.2 YES NO YES 4 7.67 YES 5 11 0.41 102 250.6 9.32 3607.6 YES YES NO 5 8.58 YES 4 11.4 0.56 93 105.6 1.31 846.6 NO YES NO 6 4.58 YES 2 10.3 3.09 198 137.4 1.87 291 NO NO NO 7 9.58 YES 3 12.2 1.31 119 184 2.51 244.3 NO YES NO 8 4.5 YES 4 11.9 0.45 102 181.8 11.12 1798.4 YES NO YES 9 11 YES 1 10.1 1.23 59 74.2 4.53 1445.8 YES YES NO 10 3.42 NO 2 9.1 1.09 138 153.9 8.66 609.4 YES YES NO 11 8.08 YES 2 11.4 1.25 101 66.8 1.31 521.8 NO YES YES Conclusion 1.Asian prevalence of MIS-C is not as high as that reported from the West. Similarities in presentation as to age and gender were noted. 2.Most of our MIS-c patients developed periungual peeling at follow up, similarly to Kawasaki Disease. 3.Different from our typical KD population, no BCG site inflammation was found. References [1]Feldstein LR, Tenforde MW, Friedman KG, et al. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19. JAMA . 2021;325(11):1074-1087. [2]Middelburg JG, Crijnen TEM, D’Antiga L, et al. Association of Ethnicity with Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2 Infection Frontiers in Pediatrics Oct 2021 Vol 9. [3]Ang Qing, Number of children admitted for covid-19 at KKH doubles since December 2021. New Straits Times, 27 Jan 2022. [4]World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19: Scientific Brief. 2020 Disclosure of Interests None declared